Have you just injured your Achilles tendon, or you are suspected to have injured it.
Be reassured: these are quite common injuries. Now let’s educate ourselves on the treatment and healing process.
I will address the most frequently asked questions from patients who think they have just had an Achilles tendon rupture: the healing time, the treatment and rehabilitation. Whether it’s possible to walk despite the injury.
For this I rely on my knowledge as a diagnostic radiographer and of course consulting medical scientific publications on the subject matter. All references are at the end of the article.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Sept 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
▶️What does a torn Achilles tendon look like?
When you look at the back of your ankle or heel, there runs the largest tendon in the body called the Achilles tendon which connects the calf muscles to the heel.
It is made up of many strands, making it strong and flexible. It helps us in bending the foot downwards for example going up onto tiptoes and helps to push us forward when walking or running.
Image of Achilles and calf rupture location:
An Achilles tendon rupture is a tear of the tendon that connects your calf muscles to your heel bone.
▶️What causes an Achilles tendon rupture?
Achilles tendon rupture is a common injury that can occur at any age but more common in athletes.it usually occurs without warning.
🟣The Achilles tendon can be torn if there is a high force or stress on it for example activities such as football, tennis, badminton, squash.
🟣The Achilles tendon can also be damaged by injuries such as falls and slips where the foot is suddenly forced into an upward pointing position.
🟣 Sometimes the Achilles tendon is weak, making it more prone to rupture. This could be due to specific medical conditions e.g. rheumatological conditions
🟣This is where the tendon becomes swollen and painful and leads to small tears within the tendon. These tears cause the tendon to become increasingly weak and therefore more at risk to rupture.
▶️How do you know if you have ruptured your Achilles tendon?
Although it’s possible to have no signs or symptoms with an Achilles tendon rupture.
Some people experience some of these symptoms.
♦️The feeling of having been kicked in the calf
♦️Pain, possibly severe, and swelling near the heel
♦️An inability to bend the foot downward or “push off” the injured leg when walking
♦️An inability to stand on the toes on the injured leg
♦️A popping or snapping sound when the injury occurs
However, it is also important to note that:
♦️You may have ruptured your Achilles tendon and still walk.
♦️You may have ruptured your Achilles tendon and still actively move the ankle up and down.
♦️You may even manage to stand on tiptoes on both feet together though not on the injured limb alone.
♦️You may also not always have a palpable gap in the tendon.
If you go to the doctor with symptoms or not.
They will ask you questions about the symptoms you are having. And a clinical examination will be conducted.
▶️Diagnosis of a torn Achilles tendon rupture
When you go to your doctor with a torn Achilles tendon rupture, you will be taken into a physical examination to make sure you have really ruptured your tendon.
Having symptoms alone cannot give a definite diagnosis.
Several diagnostic manoeuvres are used to determine a proper diagnosis.
Imaging
Although most acute Achilles tendon ruptures can be clinically diagnosed, tendon evaluation with:
⏭️Ultrasonography or MRI allows for an objective and definitive diagnosis and can be helpful in selecting treatment options.
Both modalities can be effective in diagnosing the full-thickness of Achilles tears {Amendola 2022}:
⏭️An X-ray may only show swelling of the soft tissues changes or another bone injury associated with an Achilles tendon rupture.
Image A: This x-ray demonstrates destruction of Koger’s fat pad, located posterior to the ankle (yellow arrow) and anterior to the Achilles tendon (white arrow). Image B, an MRI scan confirms the diagnosis of Achilles tendon rupture.
The fat pad can be obscured by the effusion and local soft tissue changes associated with an Achilles tendon rupture. Which is confirmed on the MRI scan in image B.
⏭️The Thompson test:
It is a clinical test used to examine the integrity of the Achilles tendon by squeezing the calf. It helps to identify the presence of a complete Achilles rupture.
Steps taken:
1️⃣The Thompson (Simmonds’ calf squeeze) test is best performed when you are kneeling on a chair or bench or lying prone on an examination couch.
2️⃣In either position, both feet and ankles must be free and dangling unsupported
3️⃣Gently your doctor will squeeze the normal leg, over the bulky part of the calf muscle, which will make the foot move into plantar flexion
4️⃣Then your doctor will squeeze on the injured side the foot which will not move if there is a fresh rupture of the Achilles tendon.
This is because the calf muscle is no longer connected to the foot. {Simmonds 1957}
you tube video showing the Thompson test check by Core Elements training:
▶️How do you treat a torn Achilles tendon rupture?
There are lots of studies I found about the treatment of a torn Achilles tendon rupture.
But a recent study done by (Amendola et al 2022) which sought to synthesise all knowledge about diagnosis and treatment of an acute Achilles tendon rupture was richer.
They found the following studies based on the type of treatment evaluated.
Histograms showing the number and type of studies on different treatments for an Achilles tendon rupture.
According to their study, this graph shows there are more studies evaluating the outcomes and follow ups of non-operative, surgical, minimally invasive and open repair treatments.
I will, therefore, partially rely on their results to present the different treatments for a total or partial Achilles tendon.
▶️Treatment options: there two options for treating an Achilles tendon.
🟠Nonoperative treatment (conservative/ orthopaedic treatment: Immobilisation, cast and brace?
You will be given a functional bracing, this is a specialised boot that holds your leg in a set position to allow healing of the tendon. You are allowed to put weight on the foot as much as you can.
This boot is worn all the time including in bed to ensure that the tendon is protected throughout the healing process.
🟠 Operative treatment
Surgery may be considered for certain reasons for example if you had a tendon rupture more than 2-3 weeks following injury.
Re-rupture of Achilles tendon or avulsion injuries.
1️⃣Open surgical repair for acute Achilles tendon rupture
Your surgery will make an incision through the skin and muscle of your calf to help realign the two ends of the tendon, then suture using absorbable or non-absorbable stitches. In some cases, grafts may be necessary.
2️⃣Percutaneous or minimally invasive technique.
Your surgeon will make a smaller incision then use a tiny camera with a light to help do the surgery.
Here are some of the conclusions from the meta-analysis research comparing the effectiveness and side effects of both treatments.
Open surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of re-rupture compared with non-surgical treatment {khan, 2010}
But produces significantly higher risks of other complications, including khan 2010.
♦️wound infection.
♦️Adhesions.
♦️Nerve injury
Modified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery (Zhan 2017}
Treatment algorithms across Scandinavia showed considerable variation, though operative treatment and controlled early weight-bearing was the preferred treatment in Denmark, Norway and Sweden.
Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. {Barfod 2014}
Given the available evidence, treatment decisions should largely be made based on the available rehabilitation protocol and the preferences of a well-informed patient.
▶️Can you walk with a ruptured Achilles tendon?
A conservative functional bracing protocol is used, you will be given some instructions to help with your healing and walking process.
| Week Device walking | Duration |
| 0-4 Airboat You can fully weight bear in the boot with 3 wedges as pain allows using crutches | 4 weeks |
| 5 Airboat 2 wedges weight bearing fully | 1 weeks |
| 6 Airboat 1 wedges weight bearing fully | 1 weeks |
| 7 Airboat 0 wedges weight bearing fully | 1 weeks |
| 8 supportive footwear with a single gel heel pad | 2 weeks |
This table highlights the bracing protocol followed.
♦️Your skin will be inspected daily, and your toes should be kept in a toe down position when not in the boot.
♦️️The airboat will help to minimise swelling and pain.
♦️Rest and elevate your legs as much as possible.
♦️Maintain core upper limb, hip and knee strength and keep toes moving fully to prevent stiffness.
♦️And you will be encouraged to walk or bear weight on the foot as weeks progress.
▶️Physiotherapy sessions after an Achilles tendon rupture.
You will be referred to a physiotherapy to start from week 7. Your physiotherapy will provide a physiotherapist dependent on your needs.
You will be taught some gentle strengthening exercises with light TheraBand for pointing your toes down and turning your foot in and out.
You will be taught some balance work to be completed in your boot and how to walk again without crutches.
▶️How long does it take for a ruptured Achilles tendon to heal?
Remember healing is usually different for each individual, your healing can be quick or take longer.
| Stages | Estimated healing timeline |
| Less pain | Few days to few weeks |
| Symptoms to completely settle | Several months |
| Tissue begins to heal | 2 weeks |
| Walking without crutches and bearing weight on the affected foot | Immediately to few weeks |
| Sports | Between 4 to 12 months depending on the sport. |
| Driving | Manual car for at least 9 weeks following your injury. And be able to perform an emergency stop. |
| Going back to work | Office basis work 2 weeks ,8 weeks when boot is removed.12 to 16 weeks physical job |
| Complete healing | 2 to 9 months or more and will take several more months to regain strength and flexibility. |
Duration of the different stages of recovery after an Achilles tendon rupture with or without surgery. (NHS guide)
▶️Pain after Achilles tendon surgery: Normal? How long?
You will experience pain after treatment. It will be: Moderate to severe pain.
The pain should decrease within a couple of weeks following the operation; however, some amount of pain is common and at times can persist for 3-6 months.
The pain is due to inflammation which is a substance necessary for the healing process, often causing pain and swelling.
Also, pain could be triggered by nerves passing near the injury.
Your doctor may prescribe you pain medication to help with pain management.
Pain, swelling and ankle stiffness Will improve with rehabilitation exercises and resuming activity.
We have come to the end of this article, wishing you a quick recovery.🙋
Below are some of the selected medical publications I have relied on to write this article.
📚Sources:
Amendola F, Barbasse L, Carbonaro R, Alessandri-Bonetti M, Cottone G, Riccio M, De Francesco F, Vaienti L, Serror K. The Acute Achilles Tendon Rupture: An Evidence-Based Approach from the Diagnosis to the Treatment. Medicina (Kaunas). 2022 Sep 1;58(9):1195. doi: 10.3390/medicina58091195. PMID: 36143872; PMCID: PMC9500605.
Khan RJ, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database Syst Rev. 2010 Sep 8;(9):CD003674. doi: 10.1002/14651858.CD003674.pub4. PMID: 20824836.
Mundi R, Madden K, Bhandari M. Cochrane in CORR®: Surgical interventions for treating acute Achilles tendon ruptures (Review). Clin Orthop Relat Res. 2014 Jun;472(6):1703-8. doi: 10.1007/s11999-013-3350-7. Epub 2013 Oct 25. PMID: 24158542; PMCID: PMC4016452.
Tan G, Sabb B, Kadakia AR. Non-surgical management of Achilles ruptures. Foot Ankle Clin. 2009 Dec;14(4):675-84. doi: 10.1016/j.fcl.2009.08.004. PMID: 19857841.
SIMMONDS FA. The diagnosis of the ruptured Achilles tendon. Practitioner. 1957 Jul;179(1069):56-8. PMID: 13453094.
Zhan J, Fang J, Zhang J, Cheng W, Lü H, Jing J. [Effectiveness of modified suture technique in treatment of acute closed Achilles tendon rupture]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Aug 15;31(8):952-956. Chinese. doi: 10.7507/1002-1892.201702090. PMID: 29806432; PMCID: PMC8458600.
Barfod KW. Achilles tendon rupture; assessment of nonoperative treatment. Dan Med J. 2014 Apr;61(4): B4837. PMID: 24814601.
Image from: Journal of Orthopaedic & Sports Physical Therapy
Published Online: November 1, 2011Volume41Issue11Pages904-904https://www.jospt.org/doi/10.2519/jospt.2011.0422